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General NPI Number Information
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NPI Number | 1073059309
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Entity Type | Individual
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Provider Name | GIFTY YEBOAH
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Gender | Female
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 700 MONTCLAIRE AVE
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City | FREDERICK
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State | MD
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Zip | 21701-4577
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Country | US
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Telephone | 240-801-2860
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Fax | 301-662-6943
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Provider Business Mailing Address
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Address Line | 9428 SINGLETON PL
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City | FREDERICK
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State | MD
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Zip | 21704-7838
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Country | US
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Telephone | 240-801-2860
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Fax | 301-662-6943
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R198223
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | R198223
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License Number State | MD
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